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ATTITUDES OF COLLEGE STUDENTS TOWARD SUICIDE.
Item Type text; Dissertation-Reproduction (electronic)
Authors GONZALEZ FORESTIER, TOMAS.
Publisher The University of Arizona.
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Download date 13/04/2021 03:35:02
Link to Item http://hdl.handle.net/10150/187382
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University MicrOfilms
International 300 N, Zeeb Road Ann Arbor, MI48106
8401263
Gonzalez Forestier, Tomas
ATTITUDES OF COLLEGE STUDENTS TOWARD SUICIDE
The University of Arizona
University Microfilms
International 300 N. Zeeb Road, Ann Arbor, MI48106
PH.D. 1983
ATTITUDES OF COLLEGE STUDENTS
TOWARD SUICIDE
by
Tomas Gonzalez Forestier
A Dissertation Submitted to the Faculty of the
DEPARTMENT OF PSYCHOLOGY
In Partial Fulfillment of the Requirements For the Degree of
DOCTOR OF PHILOSOPHY
In the Graduate College
The University of Arizona
1 983
THE UNIVERSITY OF ARIZONA GRADUATE COLLEGE
As members of the Final Examination Committee, we certify that we have read
the dissertation prepared by ____ ~_'o_m_a __ s __ G_o_n_z_a __ l_e_z __ F __ o_r_e_s_t_1_·e_r ____________ ___
entitled Attitudes of College Students ~Ioward Suicide
and recommend that it be accepted as fulfilling the dissertation requirement
for of Doctor of Philosophy --------------------------------------------------------
7-II-f3 Date
Datelj . k7t:; ('1J?3
Date
Final approval and acceptance of this dissertation is contingent upon the candidate's submission of the final copy of the dissertation to the Graduate College.
I hereby certify that I have read this dissertation prepared under my direction and recommend that it be accepted as fulfilling the dissertation
1-/1-83 Date
STATEMENT BY AUTHOR
This dissertation has been submitted in partial fulfillment of requirements for an advanced degree at The University of Arizona and is deposite.d in the University Li brary to be rna de a vai la ble to bor rower sunder r ul es of the Library.
Brief quotations from this dissertation are allowable without special permission, provided that accurate acknowledgment of source is made. Requests for permission for extended quotation from or reproduction of this manuscript in whole or in part may be granted by the head of the major department or the Dean of the Graduate College when in his judgment the proposed use of the material is in the interests of scholarship. In all other instances, however, permission must be obtained from the author.
SIGNED: 7~ '/3;) 4£
ACKNOWLEDGMENTS
I wish to express my gratitude to my doctoral
committee members for their support during the various
phases of this study. My committee chairman, Dr. George
Domino, was a source of ideas and strategies, for which I
thank him. Special thanks to Dr. George Hohmann for his
understanding and useful advice. Among my research assis
tants, Ms. Amy Hurley performed an excellent job. Mr.
Keith James, my statistics consultant, was a teacher too,
of the intricacies of the computer. I thank my typist, Ms.
Erika Louie, for her professional work and help in meeting
deadlines.
My wife Lillian, my children Sandra and Tomas, my
parents and my sister provided ideas, encouragement, sup-
port, and sacrificed their time.
ing and ready to type my drafts.
iii
Lillian was always will
Thanks to them all.
TABLE OF CONTENTS
Page
LIST OF TABLES
ABSTRACT . .
vi
. . . . vii
CHAPTER
1. INTRODUCTION 1
Attitudes Toward Suicide . • • • • • •• 1 Should Suicide be Prevented? 7 Assessment of Attitudes Toward Suicide 9 Assessment of Intervention Skills . . .. 11 Attitudes Toward Suicide and
Personality . . . • . • • • • • 15
2. METHOD 19
3.
4.
Sam pIe . . . . • . • . Instruments . . .•.. Statistical Analyses . • .
RESULTS .•.
DISCUSSION
SOQ-SIRI Correlation ..• . . . Personality Predictors of SOQ and SIRI
Attitude Predictors •....•. SIRI Predictors .•..
Limitations ....•..... Implications for Future Reserch •
APPENDIX A: SUICIDE OPINION QUESTIONNAIRE
APPENDIX B: SUICIDE OPINION QUESTIONNAIRE
19 21 31
32
43
43 44 44 45 50 51
53
SCORING KEY • . . . • • • • . . • . • • . 62
APPENDIX C: SUICIDE INTERVENTION RESPONSE INVENTORY . • • . • . . • . • • • . • . • 64
iv
APPENDIX D:
REFERENCES
TABLE OF CONTENTS -- Continued
SIRI SCORING KEY: LIST OF FACILITATIVE ALTERNATIVES
v
Page
• • 72
• • 74
Table
1 .
LIST OF TABLES
Contingency table for chi-square analysis of subjects who had attempted suicide and those who had not, as a function of sex
2. Results of mUltiple regression analyses to predict SOQ and SIRI scores from the California Psychological Inventory
3 •
4.
5.
scales • •
Comparison of subjects with training and without training ••••••.•••
Results of mUltiple regression analyses to predict SOQ and SIRI scores from the California Psychological Inventory scales for subjects with training ••••.•••
T-test results for SOQ and SIRI in selected demographic variables . •
vi
Page
33
36
38
39
41
ABSTRACT
At tit ud es towar d suici de ha ve been linke d to the
way health professionals and lay people behave toward sui
cidal individuals. In some instances negative attitudes
toward suicidal persons seem to have contributed to
repeated attempts or to suicide completion. This study
examines attitudes held by college students toward suicide,
explores whether their attitudes are related to their
skills at recognizing therapeutic verbal interventions, and
seeks to identify personality variables that might predict
attitudes toward suicide as well as skills at recognizing
therapeutic interventions.
Thr·ee instruments, the Suicide Opinion Question
naire (SOQ), the Suicide Intervention Response Inventory
(SIRI), and the California Psychological Inventory (CPI),
were administered to 215 volunteer undergraduates (122
males and 93 females) from introductory psychology classes.
Subjects' modal age range was 18 to 21 years. Forty-five
attitudinal items from the SOQ yielded a total favorable
ness score for each subject; skills at recognizing suicide
intervention responses to imaginary suicide callers was
rated by a SIR I score from 0 to 25.
vii
viii
The first hypothesis, that favorableness in atti
tudes toward suicide would correlate positively with skills
at recognizing facilitative 'suicide intervention responses,
was not supported by test data. The second hypothesis was
accepted in that both, favorableness in attitudes toward
suicide (SOQ scores) and recognition of facilitative
intervention responses (SIRI scores), can be predicted from
a personality test. SOQ scores were predicted positively
by CPI scales Flexibility, and Achievement via indepen-
dence, and negatively by Achievement via conformance. SIRI
scores were predicted positively by Intellectual efficiency
and Dominance, and negatively by Good Impression. The
literature identifies flexibility as one of the behaviors
of good crisis intervention workers.
An implication from this study is that students
showing more flexibility and autonomy are likely to show
also more favorableness in attitudes toward suicide.
Another implication is that students who are more intelli
gent and quick at making use of their intellectual abili
ties, who show initiative, and who have a moderate concern
about their impression on others, are more likely to
recognize intervention responses that may be helpful to
suicidal persons.
CHAPTER 1
INTRODUCTION
The communication of negative attitudes to indivi
duals who are suicidal seems to be linked to these
individuals becoming more suicidal (Bloom, 1967; Rosenbaum
and Richman, 1970). Do people who communicate such
negative attitudes lack sufficient interest or skills for
helping others; do they lack information as to what
behaviors might help suicidal
there a combination of these
individuals to
factors? Are
improve? Is
people with
positive attitudes and helpful behaviors necessarily aware
of what it is that they do or say that is helpful to the
suicidal individuals? Answers to questions like these give
direction to efforts toward suicide prevention.
This study seeks to address one of those questions:
whether there is a relation between positive attitudes
toward suicide and the identification of verbal responses
that are believed to facilitate interventions with suicidal
individuals. If a positive correlation exists, this may
support the notion of the existence of natural and sponta
neous helpers who, if identified, might not need extensive
training as suicide interventionists and could become
counselor role models.
1
Attitudes toward suicide are measured in this study
by the attitudinal items in the Suicide Opinion
Questionnaire (SOQ) (Domino, Gibson, Poling, and Westlake,
1980) • The Suicide Intervention Response Inventory (SIRI)
(Niemeyer and MacInnes, 1981) is used in this study to
measure ability to identify therapeutic responses.
This work also explores whether there are
personality tendencies linked to positive attitudes toward
suicide and linked to the ability to identify therapeutic
responses. For this purpose, the well-known California
Psychological Inventory (CPI) (Gough, 1956) is employed.
Attitudes Toward Suicide
The definition of attitudes that Anastasi (1968)
presents is appropriate for the present study:
An attitude is often defined as a tendency to react favorably or unfavorably toward a designated class of stimuli, such as a national or racial group, a custom, or an institution. In actual practice the term "attitude" has been most frequently associated with social stimuli and with emotionally toned responses.
In the area of suicidology attitudes seem to play
an important role in influencing behaviors directed toward
suicidal individuals. At present in our society certain
negative attitudes toward suicide seem to influence the
behaviors of significant others toward suicidal people
(Andriola, 1973; Ansel and McGee, 1971; Bloom, 1967;
Go1dney and Bottri11, 1980; Hackel and Asimos, 1981; Motto
2
and Greene, 1958; Rockwell and O'Brien, 1973; Rosenbaum and
Richman, 1970) • Although no cause and effect relationship
can be demonstrated, there are instances where the
attitudes held toward suicide have shown a significant
connection with the interpersonal relations shown toward
suicidal individuals (Bloom, 1967; Rosenbaum and Richman,
1970).
Bloom's (1967) study on suicide at a training
center and Rosenbaum and Richman's study (1970) on the
reactions of families to the suicidal attempts of some of
their members illustrate the notion that the attitudes
portrayed by significant others in the suicidals' Ii ves
influence their self-acceptance and can lead to suicide
attempts.
Rosenbaum and Richman (1970) interviewed 35
suicidal patients and as many members of their families as
they could. Each family was interviewed as a group, with
the suicidal member included. Fifteen non-suicidal
patients and their families were also interviewed for
comparison. An analysis of these interviews indicated that
several factors stood out in the lives of the suicidal
patients: (1) the presence of death wishes directly communi
cated to the patients by family members; (2) direct blaming
by family members to the patient, as well as the tendency
of the patient to passively acknowledge the blame and not
be able to defend him/herself; (3) the unavailability of
3
persons who
individual.
could provide
The authors infer
support to
that "death
the suicidal
wishes become
particularly potent when the patient has no one to support
or side wi th him." In one of their case samples they
mention an alcoholic father who attempted suicide after he
became the scapegoat in
who had always assumed
a family where the oldest daughter,
the major mothering role, had just
moved away to live in another state.
Bloom (1967) made a retrospective analysis of 32
cases of suicide where the victims had been patients in a
psychiatric training center. In this article Bloom
examined in detail the psychotherapeutic relationship in
six cases in which the patient committed suicide while in
psychotherapy. This relationship was analyzed using the
psychoanalytical concepts of the psychodynamics of
depression and transference-countertransference. Bloom
underscores the rejection by all the significant figures at
the times when patients are in a "regressed" state as "the
key factor" in most of the suicides he reviewed. He
writes: "In some cases, especially when there is an intense
transference, the rejection by the therapist may play a
crucial role, since he has become the most important person
in the patient's life" (Bloom, 1967). Therapists who offer
considerable support to their clients, particularly in
times of crisis, during which the latter may become more
dependent and demanding, may be the only allies those
4
clients have. Such therapists probably have particular
attitudes and personality characteristics which may allow
them to withstand the pressures of their patients' demands,
exert adequate judgment as to the amount of support to
offer, and maintain self-confidence and genuineness.
According to Par1off, Waskow, and Wolfe (1978),
existentialists and humanists have placed primary value on
the human qualities of the therapists as a contributing
factor to effective psychotherapy. Par10ff and co-writers
(1978) quote Jung, who wrote in 1934 that "It is in fact
largely immaterial what sort of techniques he uses, for the
point is not the technique . the personality and atti
tude of the doctor are of supreme importance--whether he
appreciates this or not." Par10ff and co-authors (1978)
suggest that good therapists should share certain charac
teristics. They list "various prescriptions for the ideal
psychotherapist" as presented by different authors they
mention. The list includes objectivity, honesty, capacity
for relatedness, emotional freedom, security, integrity,
humanity, commitment to the patient, intuitiveness,
patience, perceptiveness, empathy, creativity, and imagina
tiveness.
In a
ity, Hiler
per ce i ved as
study analyzing patient-therapist compatibi1-
(1958) concluded that therapists who are
warm by their patients retain in treatment
5
significantly more patients from all socioeconomic status
levels than therapists rated as cold, distant, or passive.
The above descriptions are pertinent to the
attitudes and personalities of crisis telephone workers,
who often perform crucial interventions with suicide
persons. According to Litman (1966), good crisis-line
workers should show certain qualities:
To func tion well as a telephone therapist, the interviewer should have a talent for interpersonal communication, a willingness to become personally involved, and a need to rescue people in trouble. The danger of overinvolvement with patients is real.
Certain attitudes and personality attributes have
been noticed in crisis telephone volunteers when these
workers have been compared to non-volunteers, particularly
to untrained college students (Smart, 1972; Tapp and
Spanier, 1973). Tapp and Spanier (1973) describe their
volunteer telephone counselors as more self- actualizing
and as showing a greater degree of openness
(self-disclosure) than the group of college students they
studied. Smart (1972) found more flexibility, autonomy and
independence in telephone volunteers than in untrained
college students.
Although no particular style claims to be success-
ful with suicidal clients, a particular style seems to be
favored from the standpoint of crisis intervention therapy
(Hatton, Valente, and Rink, 1977a; Litman, 1966; Niemeyer
6
and MacInnes, 1981). This style seems to be embodied in
the Rogerian approach of empathy, genuineness, and accurate
und er stand ing (Meador and Roger s, 1979) and a1 so inc1 ud es
contract-type variants which helpers can use for increasing
directiveness and providing structure when lethality grows
high (e.g., Hatton et a1., 1977a; Niemeyer and MacInnes,
1981).
Should Suicide be Prevented?
The majority of people in the United States would
probably agree that suicide should be prevented. However,
some suicido10gists have raised the issue of how suicide
prevention may interfere with people's right to kill them-
selves. The issue seems to involve a balance between the
values of life and of liberty (Heilig, 1977). Heilig
(1977) describes at length the ambivalence of suicidal
persons, and this description raises the questions of
whether many suicidal individuals are really free when they
choose suicide or if they are not led into that choice by
circumstances. After describing two case-histories of men
who committed suicide but whose deaths ocurred several days
after the attempt, Heilig writes, "Obviously, these men
both died by suicide, but given some additional time to
consider whether or not they wanted to die, both changed
their minds and decided they wanted to live." Heilig adds,
"It is not really death which is wanted but rather an end
7
to suff ering and pain." On a somewhat different vein,
Pretzel (1977) states:
Suicide is a highly personal act and although it does affect the culture in general and certain specific related individuals in a special way, I think we have often gone too far in trying to protect individuals from their own wishes about their own death.
Pretzel criticizes psychiatric labeling and involuntary
commitment of suicidal patients and suggests that much of
this may be done not for the suicidal person's peace of
mind but rather for that of the counselor's. Pretzel's
conclusions, however, do not deviate from what probably is
a counselor's reasonable attitude:
What I do feel lowe all my patients and all my friends is the benefit of my experience, knowledge, and whatever caring I can offer. I want that person to listen to me--1isten to my reactions to his situation, my suggestions if any, and my thoughts about the possible influence his suicide may have on his family. And I want that person to explore seriously whatever other possible alternatives may be open to him.
Attitudes showing more acceptance of, favorab1e-
ness, or positiveness toward the suicide phenomenon seem to
be appropriate tools for the prevention of suicide. Yet,
can much acceptance be too much and perhaps faci1i ta te
rather than help to prevent suicide?
Farberow's (1975) review of the history of suicide
suggests that attitudes toward suicide tend to be open and
flexible among more intellectual groups in times when the
8
societies involved were more knowledge-oriented rather than
tradition-oriented. He also suggests that:
• the rate of suicide has been high or low in part~cu1ar eras in direct relationship with variations in social controls and different emphases on the value of the individual in comparison with the state, such as idealization of reason, rationality, individuality, and democratic processes. Where the controls were the greatest, the rate was lower; where the indi vidual was more free, the rate was higher.
Domino, Moore, Westlake and Gibson (1982) suggest that an
understanding of attitudes held toward suicide is important
for the implementation of educational and preventive serv-
ices.
Assessment of Attitudes Toward Suicide
Attitudes toward suicide and suicidal persons have
been measured in several ways. Go1dney and Bottri11 (1980)
used the semantic differential approach to tap "sympa-
thetic" vs. "non-sympathetic" feelings reported by staff
members of general hospitals who had initial contact with
patients who had attempted suicide. This method used a
five-interval scale and offered mean ranks for each of 13
staff groups studied. The semantic differential was also
used by Ansel and McGee (1971). The scales used to explore
the attitudes of hospital staff, of the police, and of lay
public toward attempters were "good-bad," "high-low,"
"positive-negative," and "reputable-disreputable." Each of
these was represented by a seven-point scale. Another
9
10
method has been to use open-ended questions. Ginsburg
(1971) used this method in exploring public conceptions and
attitudes about suicide.
Domino and co-workers (1980) used a five-point
scale (i.e.,
and strongly
strongly agree, agree, undecided,
disagree) to quantify opinions and
disagree,
attitudes
to an extensive list of questions given to college
students. Their 100-item instrument, the Suicide Opinion
65 items that are Questionnaire (SOQ), contains about
considered attitudinal (e.g., "If someone wants to commit
suicide, it is their business and we should not
interfere"), and about 35 items that measure factual knowl
edge (e.g., "The large majority of suicide attempts result
in death"). In this study (Domino et al., 1980) 400 male
and 400 female undergraduate students from nine different
colleges answered the SOQ. Item analyses showed wide
heterogeneity in
endorsed strongly
students' attitudes: some items were
by
reflected indecision;
a majority of
while still
students; other items
others showed split or
opposite opinions among students. The majority of students
showed solid views toward "the sanctity of human life and
human dignity"; most seemed to have sensitive attitudes
toward suicidal indi viduals and toward the seriousness of
all suicidal attempts, and some showed low approval of the
phenomenon per see Need for educational action was evident
11
too, based on the fact that many students reflected little
factual knowledge about suicide.
The SOQ was a1 so use d to anal y ze fac tor s in vol v ed
in suicide attitudes (Domino et al., 1982). A factor
analysis of
factors that
provided by 285
for 76.6% of
responses
accounted
subjects yielded 15
the total variance.
Some factors relate, among other things, to acceptability
of suicide, immorality of the act, aggressiveness involved,
religious convictions, and to motivational aspects. In a
study comparing attitudes held by Mexican-Americans and by
Anglo-Americans toward suicide, Domino (1981a) found signif
cant differences in 35 of the 100 SOQ items. In a similar
study Domino, Cohen, and Gonzalez (1981) also found statis
tically significant differences in 35 out of the 100 SOQ
items, between Jewish and Christian subjects. Results
suggest complexity in attitudes toward suicide and hetero
geneity both within and between religious groups.
Assessment of Intervention Skills
In the area of evaluation of intervention skills
with suicidal clients, several scales or structured assess
ment systems have been developed. Fowler and McGee (1973)
developed the Technical Effectiveness Scale which basically
resembles a check-list by which an evaluator of telephone
counselors determines whether these followed through wi th
the expected steps during a crisis call (e. g., gathering
12
specific information, communicating willingness to help,
attempting to obtain certain commitments from the client).
Knickerbocker and McGee (1973) describe three
differentiated scales for empathy, warmth, and genuineness
which they used for rating professional and non-profes
sional volunteers whose interventions had been audio-taped.
Williamson, Goldberg, and Packard (1973) used patient
confederates who called up a counseling center and then, by
using specific checklists, evaluated the help they received
from specific counselors.
Niemeyer and MacInnes (1981) constructed a 25-item
multiple-choice questionnaire, the Suicide Intervention
Response Inventory. These authors explain that the SIRI
measures ability to recognize facilitative intervention
responses and not necessarily an ability to produce them.
Each SIRI item presents a remark by an imaginary suicidal
caller and two different response alternatives to the
remark. One of the alternatives is facilitative from the
standpoint of crisis theory; the other choice is consid
ered by the authors to be deleterious to effective inter
vention (Niemeyer and MacInnes, 1981). Respondents are
asked to choose "the alternative they believe to be more
appropriate. Niemeyer and MacInnes (1981) selected their
subjects from among paraprofessionals working at crisis
intervention agencies, from one group of alcohol counselor
trainees, and from among students enrolled in either of two
13
adult education classes (one in introductory psychology and
the other concerning death and dying). All crisis-worker
trainees completed the SIRI during the first and last
training sessions prior to their service in a hot line
center. Training consisted of three months of weekly
meetings. All other groups were administered the SIRI
before and after the three-month interval. The authors
report significant differences in the groups on their SIRI
scores before and after the three-month crisis intervention
training. No significant pre-post SIRI mean score
differences were found among control groups.
One of the control groups in the above study,
psychology students without any prior training in crisis
in ter ven t ion or cou rse s on dea th and dy ing , showe d, when
compared to other control and to all groups with training,
the lowest SIRI mean score (about 17.8) and the largest
standard deviation (about 5.0). Niemeyer and MacInnes
(1981) suggest that on the basis of these results, the SIRI
may be useful for assessing ability to recognize facilita
tive responses among people who are not trained in crisis
intervention.
The above-mentioned score variability in recogniz
ing facilitative responses is not associated with training,
since those subjects were given none. There might have
existed a variability in attitudes toward suicide co-
varying with SIRI scores. That this may be true for
14
lay people (e.g., untrained college students) may be deduced
from the fact that the evaluation of attitudes has been
described as one of the criteria used in the selection of
crisis helpers (Motto, Brook, Ross, and Allen, 1974).
Motto and co-writers (1974) mention that lecture-discussion
sessions have been used by the Samaritans, a British group
who assist potential suicide victims, as a means for identi
fying "unhelpful attitudes" and screening out those unquali
fied to work as Samaritan Helpers.
Variability in SIRI scores among college students
not trained or experienced in crisis intervention may corre
late with variability in favorableness of attitudes toward
suicide as measured by the SOQ. This may be true, espe
cially if the continuum favorableness-unfavorableness in
attitudes'toward suicide holds for the SOQ: in spite of the
fact that the SOQ attitudinal items represent a heterogen
eous variety (Domino et al., 1982), most of these items can
be seen also as reflecting a greater or lesser degree of
value judgment about causes of suicide, about motivations
of suicidal persons, and about the act of suicide per se.
More positive or favorable SOQ attitudinal responses
suggest less of a judgmental attitude. Therefore both SIRI
and SOQ may correlate positively in university students
enrolled in introductory psychology courses, who have had
no courses on death and dying or crisis intervention
training. Specifically:
15
HI: The ability to identify facilitative responses to
suicidal persons as measured by the SIRI will be
related to favorableness in attitudes toward
suicide, as measured by the SOQ.
College students may find themselves having to deal
with a suicidal friend or relative at some point. As such,
they would be playing the role of "gatekeepers" (Roberts,
1975) or mediators between people in mental distress and
the professionals or para-professionals trained to assist
them. Gatekeepers are usually the first source of support
sought by distressed individuals who are trying to get rid
of stressful feelings.
tant to the way they
help.
Gatekeepers' attitudes may be impor
react toward those who seek their
Attitudes Toward Suicide and Personality
A basically favorable attitude toward suicide and
suicidal individuals is desirable when a person is trying
to help suicidal people. This is implied in a book by
Motto and co-authors (1974), as well as i.n other studies
mentioned earlier where attitudes held toward suicide were
linked to the interpersonal approach followed toward
suicidal individuals (e.g., Bloom, 1967; Rosenbaum and
Richman, 1970).
Specific personality attributes which have been
listed as desirable for professionals and paraprofessionals
16
in their treatment of suicidal clients include: sensitiv
ity, warmth, interest, concern (Farberow, 1961), emotional
stability, emotional maturity, ability to tolerate
pressure, low anxiety, tolerance for frustration, and
insight into one's own personality and problems (Motto et
a1., 1974). Yet among an extensive list of personality
variables, which ones correlate more highly with attitu
dinal favorableness toward suicide? This study seeks to
identify personality variables that may be correlated with
attitudes toward suicide as measured by the SOQ attitudinal
items.
Personality factors might be identifiable too,
among persons who show ability to recognize facilitative
intervention responses, but it is not clear what person
ality variables may identify students with higher skills at
recognizing such intervention alternatives. The following
hypothesis was therefore postulated:
H2 : The ability of college students to identify
facilitative responses toward the suicidal, and attitudinal
favorableness toward suicide can be predicted from a
personality inventory.
The California Psychological Inventory (CPI)
(Gough, 1956) was considered appropriate for fulfilling the
above goal because of its varied pool of personality
descriptors and suitability for use with normal
17
populations, and because of the extensive research
generated by this instrument (Anastasi, 1968).
Among research studies that may have some bearing
on the present work, the CPI has been used, for instance,
to exami ne the rela t ionshi p bet ween counse lor per sona Ii ty
and interview behavior (Freedman, Antenen, and Lister,
1967), to explore personality differences between crisis
hotline volunteers and controls in university settings
(Smart, 1972), to analyze directiveness of counselor verbal
beha vior (Bohn, 1965), and to screen vol un teer alcoholism
counselors (Covner, 1969).
Freedman and co-workers (1967), in their study of
the relationship between counselor personality and inter
view behavior, analyzed the verbal responses of 37 guidance
and counseling students during a role-playing interview
with a coached client. CPI variables that accounted for 3%
or more of the variance predicted 81% of probing behavior,
79% of interpretive behavior and 72% of supportive and of
understanding behaviors, among other results. Smart (1972)
found that experienced telephone volunteers showed higher
flexibility and lower socialization scores than controls.
Bohn (1965) found no relation between dominance (CPI) and
the degree of directiveness shown by counselors (graduate
and undergraduate students) to multiple-choice response
questionnaires filled out while listening to tape record-
ings of simulated clients. In Covner's (1969) study,
18
community volunteers, some of whom were alcoholics,
underwent an eight-week training and were assigned to try
to get alcoholics of 242 families to quit drinking and
become involved in treatment. After 11 months of
performance, two CPI
sucessfu1 counselors.
variables significantly predicted
These counselors showed higher
Femininity scores and much lower Dominance scores than
unsuccessful counselors.
CHAPTER 2
METHOD
Sample
The sample in this study consisted of 215 college
students enrolled in a college-level introductory psychol-
ogy course. These students responded voluntarily to posted
advertisements. Volunteers were offered ten extra-credit
points toward their course grades for the completion of
three paper-and-pencil questionnaires. Out of 249 students
who volunteered, 232 completed the three questionnaires and
received their extra points. This group was then reduced
to the final 215 subjects, because 17 did not complete all
of the questions that were necessary for the present study.
The final sample of 215 consisted of 122 male and
93 female subjects. The modal age span for the sample was
between 18 and 21 years. Subjects also described them-
selves according to other categories (see Appendix A).
Some of these categories were based on whether (1) they had
taken a course on "death-and-dying" or crisis intervention
or worked for a crisis center; (2) whether they had ever
~riously considered suicide; (3) ever attempted suicide;
(4) personally known someone who had committed suicide; (5)
whether their own probability of attempting suicide at some 19
20
point in their life was zero, less than 10%, 50-50,
somewhat probable, or highly probable; and (6) whether
their responses to the SOQ should be accepted as fully
honest, accepted with reservation, probably disregarded, or
disregarded as not valid. The categories that were given
more close attention in the present study are sex, training
in crisis intervention or death-related topics, and degree
of credibility that subjects thought their responses should
be given.
Validity of subjects' responses was analyzed by two
methods: (1) by their response to question 111 of the SOQ
which, as mentioned above, asked subjects to express their
judgment as to the degree of validity of their own
responses to the questionnaire; and (2) by the subjects'
scores on the three CPI validity scales: Well-being (Wb),
Good Impression (GI), and Communality (Cm). Wb can be used
to identify individuals who try to present a picture of
inordinate distress, GI is sensitive to attempts to present
an abnormally good psychological state, and Cm is elevated
when the test is answered in a random or careless way.
Given the above methods, none of the subjects needed to be
eliminated from the sample, since none showed consistently
deviant protocols.
21
Instruments
Three standardized paper-and-penci1 questionnaires
were employed in this study: The Suicide Opinion Question
naire (SOQ), the Suicide Intervention Response Inventory
(SIRI), and the Ca1ifonia Psychological Inventory (CPI).
The Suicide Opinion Questionnaire is a 100-item
questionnaire consisting of factual and of opinion-based
information about suicide (Domino et a1., 1982). In the
construction of the Suicide Opinion Questionnaire, about
3000 items were selected by means of an extensive review of
the literature on Suicide (Domino et a1., 1982). After
eliminating poorly worded and closely similar terms, the
remaining items were given to judges including experienced
crisis interventionists, psychologists working with
suicidal patients, and graduate students from various
disciplines. As a result of the judges' comments, a pool
of 138 items was retained and administered twice to 96
college students, with a 6-week interval. The 100 items
with the highest test-retest re1iabi1ities (all above .68)
were retained as the final version of the Suicide Opinion
Questionnaire.
These 100 items had
type scale format (Anastasi,
been classified in a Likert-
1968) with items presented in
the form of statements to stimulate graded responses (i.e.,
strongly agree, agree, undecided, disagree, and strongly
disagree). These were assigned points from 1 to 5. A
22
group of three judges who were experienced in clinical
intervention with suicidal patients were asked to sort the
SOQ items into either factual or opinion items; items were
classified as factual or attitudinal as a result of judges'
unanimous consensus (Domino, 1981b).
A factorial analysis of the SOQ, using a principal
component solution with normalized varimax rotation,
yielded 15 factors which accounted for 76.7% of the total
variance in a study where a total of 285 adult volunteers
(139 males and 146 females) responded to the 100 items in
the questionnaire (Domino et a1., 1982). The first three
factors consisted of 16, 13, and 7 items, respectively,
with factor loadings above .30, a value arbitrarily
selected as the cut-off point by the authors. The other 12
factors contain from six to three items, each with factor
loadings above .30. Domino and co-authors (1982) suggest
that based on these results, attitudes toward suicide are a
rather complex phenomenon and that an analysis of atti
tudes, based solely on favorab1eness-unfavorab1eness of
attitudes toward suicide may be simplistic for an under
standing of the phenomenon.
Domino (1980) did a pre-post study in which
students enrolled in an abnormal psychology course
responded to the SOQ at the beginning and ten months after
the end of the course. Seventeen students who as part of
their course requirements had been assigned to do an
in-depth
subjects
investigation
used in this
23
on the topic of suicide, were the
analysis. As part of their course
requirement, students had been assigned readings and book
reports on suicide texts, had heard therapy transcriptions
of suicidal
invol ved in
patien·ts, and had
suicide prevention
met with
as well as
professionals
with suicide
attempters. The author reports that the SOQ questionnaires
"were scored on fi ve areas based on the resul ts of prior
factor analyses: (a) Normality of suicide (22 items account
ing for 16.8% of the variance, e.g., "Potentially everyone
of us can be a suicide victim"); (b) Motivational aspects
(18 items, 16.2% variance, e.g., "Most suicide attempts are
impulsive in nature"); (c) Religious-moral aspects (19
items, 13.9% variance, e.g., "People who commit suicide
lack solid religious convictions"); (d) Demographic dimen
sions (9 items, 8.7% variance, e.g., "The suicide rate is
higher for blacks than for whites"); and (e) Risk (8 items,
7.6% variance, e.g., "A person whose parent has committed
suicide is a greater risk for suicide").
Results showed significant changes in the first
four areas mentioned above, among the 17 subjects. No
control groups were employed in the study. According to
Domino, "these results may be viewed in the context of an
initial study which nevertheless suggests that attitudes
toward suicide can indeed be altered in a more positive
direction" (Domino, 1980).
24
Other studies wi th the Suicide Opinion Question
naire have shown differences in groups whose opinions about
suicide are expected to differ along factors like religion
and ethnicity (e.g., Domino, 1981a; Domino, Cohen, and
Gonzalez, 1981). Additional validity studies for the SOQ
are in progress.
The 100 SOQ items consist of 35 items based on
factual information about suicide (e.g., "In the U.S.
suicide by shooting oneself is the most common method") and
65 based on opinions about
acceptable means to end an
suicide
incurable
(e.g., "Suicide is an
disease"). Of these
65 items, 46 were identified in the test's scoring key as
scorab1e by means of a favorable-unfavorable continuum (see
Appendix B). These 46 items were the ones actually used
for analysis in the present study although the entire
questionnaire was administered (Appendix A lists these
items). In this study the SOQ attitudinal score for each
subject consisted of a single score obtained by adding the
individual scores from the 46 items employed.
Theoretically, scores could range from 46 to 230.
In addition to the 100 items, the SOQ contains
seven items for demographic information-gathering purposes.
Four new demographic items were added (items 102, 103,108
and 109 in Appendix A) to get information of interest for
the present study.
25
The second questionnaire administered to subjects
was the Suicide Intervention Response Inventory (Niemeyer
and MacInnes, 1981). As described earlier, this is a
25-item multiple choice questionnaire (see Appendix C).
Each item presents a remark by an imaginary suicide caller
and two response alternatives. Subjects are asked to
choose which of the two responses would be helpful to the
client in distress; the other response is considered to be
deleterious. For example, these are two SIRI items:
Client: I really need help it's just
Client:
(voice breaks; silence). Helper A: It must be very difficult for you
to talk about what's bothering you.
Helper B: Go on. talk.
I'm here to listen to you
I have a gun pointed at my head right now, and if you don't help me, I'm going to pull the trigger! Helper A: You seem to be somewhat upset. Helper B: I want you to put down the gun so
we can talk.
Each correct response in the SIRI (see Appendix D)
is given a score of 1; thus, anyone subject can score up
to 25 points. For each subject in this study, SIR I scores
consisted of one single total score with a potential range
from 0 to 25.
In the validation study for the Suicide Interven-
tion Response Inventory, crisis-worker trainees completed
the questionnaire in group administrations during the first
and last training sessions prior to their serving in a
26
c r isis-line se rvice (Ni emeyer and Mac Innes, 1981). Their
training spanned over three months of weekly meetings.
Control groups were administered the SIRI before and after
the 3-month period. Several methods for investigating
SIRI, construct validity were followed. First, a
known-groups comparison method was used. The reasoning
followed in this study was that if the SIRI actually
measured skill in choosing an appropriate response to a
suicidal client, then experienced hotline crisis workers
should receive the highest scores, fallowed by crisis-line
trainees and finally by untrained subjects. Statistically
significant differences were found as predicted, among the
three groups, with experienced workers showing highest SIRI
scores (x = 24.49, SD = 1.05), followed by the scores of
volunteers in training (x = 20.86, SD = 4.03), and by those
of untrained psychology students (x = 17.98, SD = 4.64).
This analysis was performed on data obtained in the first
of the two SIRI administrations.
A second method for assessing SIRI construct
validity was by measuring the effect of training on SIR I
scores. Theoretically, the SIRI taps skills that should be
affected by training in crisis intervention. Thus,
Niemeyer and MacInnes (1981) predicted that SIRI scores
would increase over the 3-month period for those subjects
receiving training (N = 127) while no significant changes
should occur among control subjects (introductory
27
psychology students, N = 18; death education students, N
15; veteran crisis counselors, N = 18). Trainees showed a
statistically significant increase in scores (from -x =
20.89, SD = 3.69, to x = 23. OS, SD = 2.30) while no signi-
ficant change was noticed among controls (from x = 21.57,
SD = 4.29, to -x = 22.0$ SD = 4.36).
A third approach to assess SIRI construct validity
was by investigating its correlation with a previously
validated instrument measuring a similar skill. Niemeyer
and MacInnes (1981) did this by comparing trainees' scores
on the SIRI to their scores on a film technique for assess-
ing global therapeutic skills. The film employed was the
Counseling Skills Evaluation film (Wolf and Wolf, 1974).
Subjects' ratings of the helpfulness of several simulated
counseling scenarios were compared to the ratings of expert
judges. Correlations between the SIRI and split-half items
of the film were r = .58 at the beginning of training and r
= .66 after the 3-month period.
Reliability for the SIRI was assessed by and
analysis of internal consistency using a Kuder-Richardson
20 formula to calculate an average inter-item correlation.
A correlation of .84 was obtained. Additionally, a test-
retest analysis showed an r = .86 over the 3-month period
for subjects used as controls (Niemeyer and MacInnes,
1981).
28
The California Psychological Inventory (Gough,
1956) was administered to subjects. This test offers a
variety of personality descriptors based on the behavior of
normal people and thus would be suitable for the population
to be sampled in this study. The CPI is a well-known and
extensively researched instrument (Anastasi, 1968). This
instrument consists of eighteen scales to represent
different behavioral tendencies. Raw scores are converted
to T-scores for easy comparison between scales. The appro-
priateness of the CPI to this study is reflec ted in this
description by Gough (1968) regarding the choice of test
items:
Because the instrument is intended for the diagnosis and comprehension of interpersonal behavior, the concepts selected are those that occur in everyday social living and, in fact arise from social interaction. Most simply, such variables may be described as "folk concepts"--aspects and attributes of interpersonal behavior that are to be found in all cultures and societies, and that possess a direct and integral relationship to all forms of social interaction.
The California Psychological inventory consists of
480 items, 178 of which were taken from the Minnesota
Multiphasic Personality Inventory. The test consists of
the following 18 scales, grouped for convenience into four
classes or broad categories:
Class I: Measures of Poise, Ascendancy, Self-
Assurance, and Interpersonal Adequacy.
1. Dominance (Do)
29
2 . Capacity for Status (Cs)
3. Sociability (Sy)
4. Social Presence (Sp)
5. Self-acceptance (Sa)
6. Sense of Well-being (Wb)
Class II: Measures of Socialization, Responsibil-
ity, Interpersonal Values, and Character.
7. Responsibility (Re)
8. Socialization (So)
9. Self-control (Sc)
10. Tolerance (To)
11. Good Impression (Gi)
12. Communality (Cm)
Class III: Meas ure s of Achie vemen t Potentia 1 and
Intellectual Efficiency.
13. Achievement via Conformity (Ac)
14. Achievement via Independence (Ai)
15. Intellectual Efficiency (Ie)
Class IV: Measures of Intellectual and Interest
Modes.
16. Psychological-mindedness (Py)
17. Flexibility (Fx)
18. Femininity (Fe)
30
Gough (1975) and Megargee (1972) present data on
reliability and validity studies for the CPl. In one test
retest reliability study, 125 female and 101 male high
school students took the CPI during their junior year and
again a year later as seniors (Gough, 1975). Test-retest
correlations for females ranged betwen .44 and .77 for the
18 scales; correlations for males ranged between .38 and
.75. In another test-retest study 200 male prisoners took
the test twice with a lapse of from 7 to 21 days between
testings (Gough, 1975). Test-retest correlations for this
study ranged from .49 to .87. There is considerable
variability in internal consistency; for example, Megargee
(1972) reports coefficients ranging from .22 to .94 when
applying Kuder-Richardson Formula 21 to the means and
standard deviations for the largest normative group
presented in the CPI Manual (Gough, 1975): 3,572 male and
4,056 female high school students.
The 18 CPI scales were not all derived in the same
manner; some were derived by correlations with other tests,
some were originally constructed as MMPI scales and later
revised for inclusion in the CPI, and for a few scales no
clear derivation procedure is reported (Megargee, 1972).
Evidence for validity varies for the different scales; the
assessment of validity is based largely on differences
between extreme groups. For the Dominance scale, for
example, correlations ranging from .40 and .48 were found
31
with ratings based on pooled dominance ratings done by
University of California personality research staff on
military officers and medical school applicants (Gough,
1975). Validity studies reported by Gough (1975) show
correlations for the 18 CPI scales ranging from .25 to .58
with ratings done by University of California personality
research staff. Correlations of the CPI with several other
personality tests are also reported (e.g., the MMPI,
Ca t te 11 l6PF Tes t, Edwar d s Per sonal Pre f erence Sche dule)
(Gough, 1975).
Statistical Analyses.
Response differences between male and female
subjects were examined by means of t-tests and chi-square
analyses. Next, a Pearson correlation analysis was run to
compare SOQ and SIRI responses and thereby test Hypothesis
1. Hypothesis 2 was tested by regression analyses to
predict SOQ and SIRI scores from CPI. Levels of .05 were
chosen as the significance level for all statistics.
Statistical analyses were run using the Statistical
Package for the Social Sciences (Nie, Hull, Jenkins, Stein
brenner, and Bent, 1975).
The above statistical procedures were focused on
subjects who had not taken courses on crisis intervention
or death-and-dying and who had not worked in crisis
centers.
CHAPTER 3
RESULTS
Tests for significance of differences between means
(t-tests) were run to determine whether the variable sex
had any significant effect on SIRI and on SOQ scores. Chi-
square analyses were also run to detect sex effects on six
other demographic variables (SOQ item numbers 102, 104,
105, 106, 110 and lll--see Appendix A). Only one of the
eight variables analyzed showed statistically significant
differences due to sex. This difference was in response to
SOQ question 105, "Have you ever attempted suicide?" Table
1 shows sample sizes and percentages for this variable,
which yielded a chi-square of 3.88 (p < .05). Since the
chi-square
attempted
analysis
suicide?"
for
was
the variable "Have you ever
the onl y anal y si s that showed a
statistically significant result, and since this result
agrees with previous literature in that more women than men
do attempt suicide (Hatton et a1., 1977b), it was not
considered necessary to analyze the possibility of alpha
slippage. The number of subjects who reported having ever
attempted suicide, 3 males and 9 females, was considered
too small
reliably
to submi t to further analyses to be generalized
to the general student population. Statistical
32
Table 1. Contingency table for chi-square analysis of subjects who had attempted suicide and those who had not, as a function of sex.
Male
Female
x2 = 3.88 p < .05
Yes
2.5% n = 3
9.7% n = 9
No
97.5% n = 118
90.3% n = 84
33
.34
analyses performed from this point on did not distinguish
between subjects on the basis of sex.
A Pearson correlation analysis was run between
scores on the Suicide Opiuion Questionnaire and the Suicide
Intervention Response Inventory. This was the statistical
procedure chosen to test Hypothesis 1, which states that
"The ability to identify facilitative intervention
reasponses to suicidal persons, as measured by the SIRI, is
related to attitudinal favorableness toward suicide, as
measured by SOQ attitudinal items."
A correlation coefficient of .07 was obtained
bet ween SIRI and SOQ scores. This is not statistically
significant. As a result, the first null hypothesis,
presented below, is not rejected.
Ho: The ability to identify facilitative responses to
suicidal persons, as measured by the SIRI, is not
related to attitudinal favorableness toward sui
cide as measured by SOQ attitudinal items.
Regression analyses were run next, to explore the
second hypothesis, which states:
H2 : The ability of college students to identify facili
tative intervention responses to suicidal persons,
as measured by the SIRI, and attitudinal
favorableness toward suicide, as measured by the
SOQ can be predicted from a group of personality
35
factors, as measured by the California
Psychological Inventory.
Table 2 shows the results of the stepwise mUltiple
regression analyses run to predict SIRI scores and SOQ
attitudinal scores from the California Psychological
Inventory. As shown in that table and as expected from the
results of H , CPI predictors for SOQ scores are different
from SIRI predictors. Suicide Opinion Questi0nnaire scores
are best predicted by the CPI scales of Flexibility (Fx),
Achievement via conformance (Ac), and Achievement via
independence (Ai). These results are statistically
significant and account for .20 of the variance in SOQ
scores. Both Fx and Ai turned out to be positive
predictors pf SOQ scores, while Ac showed an inverse corre-
lation with these scores.
The CPI scales that best predicted for the Suicide
Intervention Response Inventory scores are Intellectual
efficiency (Ie), Good Impression (GI), and Dominance (Do)
(see Table 2). Together they account for .08 of the
variance in SIRI scores. Whereas the Ie and Do scales show
a positive correlation with SIRI scores, GI shows an
inverse correlation.
From the above results, Hypothesis 2 is accepted to
read that:
The ability of college students to identify facilitative intervention responses to suicidal
Table 2. Results of multiple regression analyses to predict SOQ and SIRI scores from the California Psychological Inventory scales (N = 215).
CPI Predictors Multiple Increm~nt
Correlation (R) in R F Simple r
SOQ Regression
Flexibility (Fx) .34 .12*** .34
Achievement via .40 .04*** 11.41*** -.13 conformance (Ac)
Achievement via .45 .04*** 11. 31 ** .26 independence (Ai)
SIRI Regression
Intellectual .16 .03* .16 efficiency (Ie)
Good Impression (GI) .24 .03-3:-* 7.56** -.11
Dominance (Do) .28 .02* 5.14* .15
* p < .05 ** p < .01 ***p < .001
tN 0\
persons, as measured by the SIRI, and attitudinal favorableness toward suicide, as measured by the SOQ, can be predicted from a group of personality factors, as measured by the CPl.
37
Because significantly different SIRI scores have
been found between experienced crisis counselors, and
college students without counseling or crisis intervention
training (Niemeyer and MacInnes, 1981), the responses of
students who reported having "taken a course on 'death-and-
dying' or on crisis intervention or worked for a crisis
center" were analyzed in the present study. Twenty-one
subjects answered YES to this inquiry. In spi te of the
sample size difference when compared to those who answered
NO to this question (21 vs. 194), two t-tests were run.
No significant difference between these two groups
(training vs. no-training) was found in their mean SOQ
scores or in their mean SIRI scores (see Table 3). A
Pearson correlation analysis for SOQ and SIRI scores in the
group with training revealed no significant correlation.
A stepwise multiple regression analysis, run to
determine which CPI variables predict SIR I and SOQ scores
among subjects with training Yielded the following results:
scales Femininity (Fe), Self-acceptance (Sa) , and
Socialization (So) were the best predictors for SOQ scores;
Dominance (Do), Femininity, and Psychological-mindedness
(Py) predicted SIRI scores best. As Table 4 shows, SOQ
scores vary positively with the Fe scale, and inversely
38
Table 3. Comparison of subjects with training and without training.
SOQ SIRI
- SD - SD x t x t rSOQ-SIRI
Training 142.57 17.31 14.48 1. 99 (n = 21)
.60 .71 0.09
No Training 140.19 14.37 14.76 2.10 (n = 194)
Total Ss 140.42 14.66 14.73 2.09 (N = 215)
Table 4. Results of multiple regression analyses to predict SOQ and SIRI scores from the California Psychological Inventory scales for subjects with training (n = 21).
CPI Predictors Multiple Increm2nt
Correlation (R) in R F Simple r
SOQ Regression
Femininity (Fe) .54 .29* .54
Self-acceptance (Sa) .62 .10 3.15 -.18
Socialization (So) .71 .12 4.44* -.33
SIRI Regression
Dominance (Do) .54 .29* .54
Femininity (Fe) .68 .17* 5.93* .42
Psychological .77 .13* 5.62* -.01 mindedness CPy)
* p < .05 ** p < .01
tN ~
40
with scales Sa and So. SIRI scores show a positive
correlation with Do and Fe, and an inverse correlation with
Py.
Interpretation of these results should be done with
caution due to the larger number of CPI variables (i.e.,
18) and comparatively small sample size (n = 21). This low
sample-to-variables ratio overdescribes the sample, and
generalization to the population would be questionable
(Pedhazur, 1982).
Some of the demographic information obtained
through the questions at the end of the SOQ (see Appendix
A) was used for fu rther anal y si s of SOQ and SI RI scores.
The information utilized was based on SOQ questions 104,
105, 106 and 110. These allowed four pairs of groups
according to whether or not subjects had ever seriously
considered suicide (104); ever attempted suicide (105);
known someone who committed suicide (106); and according to
whether their estimated probability of attempting suicide
in the future was higher or lower than 50% (110). T-tests
were run in each pair of groups to determine whether they
had significantly different SOQ or SIRI mean scores.
Table 5 presents the results of these t-tests.
Only one t-test showed a significant resul t: subjects who
reported having seriously considered suicide at some point
in the past· (N = 37) showed a significantly higher SOQ
attitude mean score (x = 145.13, SD = 12.82) than subjects
Table 5. T-test results for SOQ and SIRI
Criteria Response
x
Have you ever seriously Yes (n=37) 145.13 considered suicide?
No (n=178) 139.44
Have you ever attempted Yes (n=12) 147.25 suicide?
No (n=203) 140.01
Have you personally known Yes (n=86) 141. 09 someone who committed suicide? No (n=129) 139.97
What is the probability ~50% (n=12) 145.83 that at some point in your life that you might <50% (n=203)140.10 attempt suicide?
* p = < .05
in selected demographic variables.
SOQ SIRI
-SD t p x SD t p
12.82 14.86 1. 99 2.17* .03 .41 .68
14.85 14.71 2.12
11.19 14.42 2.15 1. 67 .10 .54 .59
14.76 14.75 2.09
14.60 14.95 1. 91 .55 .58 1. 20 .23
14.74 14.59 2.33
16.69 14.42 2.35 1. 32 .19 .54 .59
14.51 14.75 2.08
~ I-'
42
who had never seriously considered suicide (N = 178, x =
139.4, SD
significantly
= 14.85).
different
These two
in their
groups were not
SIRI mean scores.
Although there were no significant differences in SOQ or in
SIRI mean scores in any of the other three pairs of groups,
there was a trend for higher SOQ mean scores in subjects
who rated themselves as having 50% or higher chance of
attempting suicide vs. those who rated themselves lower
than 50%, in subjects who had previously attempted suicide
vs. those who had not, and in subjects who had known a
suicide vs. those who had not.
CHAPTER 4
DISCUSSION
SOg-SIRI Correlation
Results in this study did not support the hypothe
sis that positive attitudes toward suicide correlate signi
ficantly with the ability to identify helpful interven-
tions, as measured by sog and SIRI. These resul ts gi ve
support to the conclusion that the behaviors measured by
the sog and the SIRI are essentially independent of each
other, and that any commonalities in what these two
questionnaires measure were not reflected in a significant
form by the statistical analysis chosen. Therefore, a
person with a high degree of openness toward, or acceptance
of, suicidal individuals may not be able to recognize what
verbal responses might help prevent a suicide even when
that person might behave in a helpful and supportive way
when in contact with the suicidal.
Viewing these results from the endpoint of the
SIRI, an individual who is good at recognizing responses
that can facilitate suicide prevention may, however, not
experience any positive attitudes toward suicidal persons,
let alone the possibility of doing or not doing effective
interventions with the suicidal.
43
44
Personality Predictors of sog and SIRI
The second hypothesis in this study, that sog and
SIRI scores could be predicted from the CPI, was accepted
and CPI predictors were presented in Table 2. The fact
that the CPI scales predicting sog scores came out to be
different from the ones predicting SIRI scores seems to
further support the conclusion that attitudes toward
suicide and ability to select helpful suicide intervention
responses as measured by the instruments used in this
study, are independent of each other.
Attitude Predictors
Higher favorableness in attitudes toward suicide is
related to higher Flexibility (Fx), higher Achievement
via-independence (Ai), and lower Achievemen t-via-conf orm-
ance (Ac) scores.
has the purpose of
and adaptability
According to Gough (1975),
indicating "the
of a person's
degree of
thinking
the Fx scale
flexibility
and social
behavior." High Fx scorers are described as "insightful,
informal, adventurous, confident, humorous, rebellious,
idealistic, assertive and egoistic; as being sarcastic and
cynical; and as highly concerned with personal pleasure and
diversion" (Gough, 1975).
The purpose of the Achievement-via-independence
scale is to "identify those factors of interest and motiva
tion which facilitate achievement in any setting where
45
autonomy and independence are pos i ti ve beha v iors" (Gough,
1975); the Achievement-via-conformance scale has a similar
purpose except that the factors to be identified are those
where conformance is the positive behavior that may lead to
achievement (Gough, 1975). Ai and Ac correlate about 0.39
(Gough, 1968), and Gough suggest s that con se quen tly the
tendency will be to find people scoring high on both or low
on both. According to the CPI Manual (Gough, 1975), high
Ai scorers tend to be seen as "Mature, forceful, strong,
dominant, demanding, and foresighted; as being independent
and self-reliant; and as having superior intellectual
abi1i ty and judgment." Similarly, those who score high on
Ac are seen as "Capable, cooperative, efficient, organized,
responsible, stable and sincere; as being persistent and
industrious; and as valuing intellectual activity and
intellectual achievement."
Fx and Ai are the two highest CPI predictors of SOQ
scores and Ac shows a lower, inverse correlation. Thus
individuals with more favorable attitudes toward suicide
are flexible and adaptable, with a great degree of indepen
dence and self-reliance, but less given to stability and
industriousness.
SIRI Predictors
SIRI scores are predicted directly by the CPI Intel
lectual Efficiency (Ie) and Dominance (Do) scales and
46
inversely by the Good Impression (GI) scale, as was
presented in Table 2. The Ie scale tries "to indicate the
degree of personal and intellectual efficiency which the
individual has attained" (Gough, 1975). Subjects who score
high on Ie are described as "Efficient, clear-thinking,
capable, intelligent, progressive, p1anfu1, thorough, and
resourceful; as being alert and well-informed, and as
placing a high value on cognitive and intellectual matters"
(Gough, 1975).
The Do scale was designed "to assess the factors of
leadership
inititive"
ability,
(Gough,
dominance, persistence, and social
1975) . Those who score high in Do are
described with the following adjectives: "Aggressive, confi
dent, persistent, and p1anfu1; as being self-reliant and
independent;
initiative"
and
(Gough,
as having leadership potential and
1975). The Good Impression scale is
designed "to identify persons capable of creating a favor
able impression, and who are concerned about how others
react to them" (Gough, 1975).
In the present study the mUltiple correlation of
Ie, GI and Do wi th SIRI scores is somewhat lower than the
multiple correlation of Fx, Ai and Ac with SOQ scores.
This suggests that CPI variables show more common variance
with SOQ attitudinal scores than with SIRI scores for this
population. In part this may reflect the greater complex
ity of the SOQ vis-a-vis the SIRI.
47
From the above results, an overall interpretation
of CPI predictions on SOQ and SIRI would suggest that
students with a positive attitude (SOQ) toward suicide may
be described as being flexible and adaptable in their
thinking and social behavior, and likely to be success
ful in goals that require autonomy and independence rather
than conformance. Students with a high ability to
recognize facilitative responses in suicide intervention
(SIRI) might be described as intelligent and resourceful,
as showing persistence and social initiative, and as
somewhat concerned about creating a good impression on
others.
Although the results of the present study were
found in a sample of students, 90% of whom (i.e., 194
subjects) had never taken courses on death and dying or had
been trained in crisis intervention, similar results have
been found among crisis-telephone volunteers. Flexibility
in volunteers' management of suicide prevention center
clients has been identified as a favorable factor in
suicide prevention (Maris, Dorpat, Hathorne, Heilig,
Powell, Stond, and Ward, 1973). As mentioned earlier,
Smart (1972) found more flexibility, autonomy and
independence in telephone volunteers than in untrained
college students.
48
Smart led a comparative study between university
hot line volunteers and controls where the CPI was used and
results showed some similarities between that study and the
present one. In Smart's study the group of interest was
made up of 134 male and female undergraduate campus crisis
hot1ine volunteers from two universities in Colorado.
Controls were 94 undergraduates from one of those universi
ties, who were advanced and successful students in their
training as school teachers. Both groups were compared by
means of the CPI and of the Self-Assessment of Attitudes
Toward Suicide Scale, a 17-item experimental instrument.
CPI resu1 ts showed that telephone
cant1y higher Flexibility scores
volunteers had signifi-
Socialization scores than
and significantly lower
Telephone volunteers
scores in the Achieve-
controls.
also showed a trend toward higher
ment-via-independence scale and a trend toward lower scores
in the Achievement-via-conformance and in the Self-control
scales. It is of interest to note that the Self-Assessment
of Attitudes Toward Suicide Scale did not statistically
discriminate betwen crisis volunteers and controls.
In the present study, some similarities with
Smart's results can be observed. First, in both studies
Flexibility (Fx) was
Fx predicted more
an important predictor: in this study
favorableness in attitudes toward
suicide; in Smart's study Fx identified hotline volunteers.
SOQ attitudinal items as predicted by Fx may be, therefore,
49
sensitive indicators of individuals who may relate well
with suicidal persons and perhaps be good agents at
preventing their suicide.
Another similari ty is that in the present study,
Achievement via conformance (Ac) and Achievement via
independence (Ai) resulted in predictor variables and in
Smart's study they showed a trend toward discriminating
line volunteers from controls. In both studies Ai varied
in the same direction as Fx while Ac varied in the opposite
direction.
The strongest conclusion in the present study
involves an association between openness in attitudes
toward suicide, and flexibility and independence as person
ality characteristics. An earlier question was whether too
much acceptance or openness toward suicide may facili ta te
rather than prevent suicide. An implication from the
present study is that a person who is autonomous is more
likely to envision diverse options to a problem and, there
fore their openness toward suicide as a phenomenon may not
necessarily create a negative influence on suicidal
individuals whom they may contact.
A significantly higher SOQ attitudinal mean score
was found in the group of students who reported having
seriously considered suicide at some earlier time in their
lives than in the group of those who had never considered
50
suicide. A similar trend was observed for subjects who
reported having attempted suicide, having known somebody
who had committed suicide or seeing it probable they might
commit suicide in the future. Future analyses might
explore whether students who have been in closer contact
with the suicide experience and who show positive attitudes
toward suicide (high SOQ scores) have SIRI and CPI results
comparable to those of students with high SOQ's and who
have not had such close contact' with the suicide pheno-
menon. This would be of interest because suicidal
individuals have been reported to show considerable
hopelessness and inability to project into the future
(Hatton, Valente, and Rink, 1977c), which would not seem to
agree with personality behaviors suggested by CPI scales
like Flexibility and Achievement via independence.
Limitations
Some limitations that may have affected results in
the present study may be found in the following areas.
First, in this study only 46 of the 65 SOQ attitudinal
items were employed because no classification among the
favorable-unfavorable continuum was available for all 65
items.
accuracy
Second,
The use of all 65 items may have added more
to the attitudinal profile of each subject.
the concep t of SOQ at ti t ud ina 1 sc ores rna y be too
heterogeneous in spite of its being separate from the
51
concept of factual knowledge. Within the group of 45
attitudinal items employed in this study, an item analysis
might identify a cluster specifically correlated with SIRI
scores. Third, to compare attitudes toward suicide with
the ability to recognize facilitative interventions address
only part of a broader issue of how attitudes toward
suicide may relate to the production of therapeutic
behaviors during intervention with suicidal persons. This
remains for future research to clarify. Fourth, the
correlation analyses performed in
analyses; analyses for curvi1iner
this study were
correlations
more substantial results. Fifth, some of
may
the
analyzed in this study contained very few subjects
12), and this limits the power of the statistical
linear
yield
groups
(e. g. ,
tests
performed. Sixth, results in this study may have been
affected by limitations in the instruments employed; the
SOQ and SIRI are still in experimental stages.
Implications for Future Research
The personality characteristics suggested by CPI
regressions should be explored further,
siona1s and lay people so as to verify
both among profes
the validity and
consistency of these results. This may
the notion that flexibility and autonomy
offer
may
support to
be healthy
personality qualities to foster as suicide primary
prevention measures. Such explorations should be used to
clarify personality differences between those
positive attitudes toward suicide run parallel to
suicide as an option for themselves and those
attitudes do not.
52
whose
seeing
whose
The favorable-unfavorable continuum of SOQ atti-
tudes should continue to be utilized and refined further so
as to capitalize on its potential because in this study,
that appeared to be a cohesive concept, predictable by the
CPI scales. SOQ at tit ud inal score s shoul d be use d with a
variety of other explorative measures--for example, with
meas ure s of
therapeutic
actual production
inverventions by
ra ther than recogni tion
professionals and
of
lay
people--and with measures of knowledge about suicide, like
the SOQ factual knowledge total score, so as to address
other questions related to the broad issue of attitude
expression and its influence upon the suicidal. These
comparisons should throw light on areas where attitudes
toward suicide should be influenced so as to contribute
toward suicide prevention.
APPENDIX A
SUICIDE OPINION QUESTIONNAIRE
S3
SUICIDE OPINION QUESTIONNAIRE
This is not a test, but a survey of your opinions; there are no right or wrong answers, only your honest opinion counts.
For each item, indicate (on the answer sheet) whether you: A. strongly agree B. agree C. are undecided D. disagree E. strongly disagree
1. Most persons who attempt suicide are lonely and depressed.
2. Almost everyone has at one time or another thought about suicide.
3. The suicide rate is higher for blacks than for whites.
4. The actual suicide rate in the U.S. is much greater than reflected by official statistics.
5. Suicide prevention centers actually infringe on a person's right to take his life.
54
6. Most suicides are triggered by arguments with a spouse.
7. The higher incidence of suicide is due to the lesser influence of religion.
8. Many suicide notes reveal substantial anger toward the world.
9. I would feel ashamed if a member of my family committed suicide.
10. Most suicide attempts are impulsive in nature.
11. Many suicides are the result of the desire of the victim to "get even" with someone.
12. In the U.S. suicide by shooting oneself is the most common method.
13. People with incurable diseases should be allowed to commit suicide in a dignified manner.
14. Those who threaten to commit suicide rarely do so.
55
For each item, indicate (on the answer sheet) whether you: A. strongly agree B. agree C. are undecided D. disagree E. strongly disagree
15. Suicide is more prevalent among the very rich and the very poor.
16. Individuals who kill themselves out of patriotism do so, not because they are courageous, but because they enjoy taking major risks.
17. Suicide is a leading cause of death in the U.S.
18. Suicide is an acceptable means to end an incurable illness.
19. People who commit suicide are usually mentally ill.
20. Some people commit suicide as an act of se1fpunishment.
21. The feeling of despair reflected in the act of suicide is contrary to the teachings of most major religions.
22. Suicide rates vary greatly from country to country.
23. I feel sorry for people who commit suicide.
24. John Doe, age 45, has just committed suicide. An investigation will probably reveal that he has considered suicide for quite a few years.
25. Suicide is acceptable for aged and infirm persons.
26. The suicide rate among physicians is substantially greater than for other occupational groups.
27. The Japanese Kamikaze pilots who destroyed themselves by flying their airplanes into a ship should not be considered suicide victims.
28. Different cultural child-rearing practices are probably unrelated to suicide rates.
29. Suicide is clear evidence that man has a basically aggressive and destructive nature.
30. Over the past ten years the suicide rate in this country has increased greatly.
56
For each item, indicate (on the answer sheet) whether you: A. strongly agree B. agree C. are undecided D. disagree E. strongly disagree
31. Most people who try to kill themselves don't really want to die.
32. Suicide happens without warning.
33. A business executive arrested for fraud or other illegal practices should face punishment like a man rather than seek suicide as an escape.
34. Most suicide victims are older persons with little to live for.
35. A person who tried to commit suicide is not really responsible for those actions.
36. About 75% of those who successfully commit suicide have attempted suicide at least once before.
37. It is rare for someone who is thinking about suicide to be dissuaded by a "friendly ear."
38. People who commit suicide must have a weak personality structure.
39. The method used in a given suicide probably reflects whether the action was impulsive or carefully and rationally planned.
40. Social variables such as overcrowding and increased noise can lead a person to be more suicide-prone.
41. A large percentage of suicide victims come from broken homes.
42. A rather frequent message in suicide notes is one of unreturned love.
43. People who set themselves on fire to call attention to some political or religious issue are mentally unbalanced.
44. The possibility of committing suicide is greater for older people (those 60 and over) than for younger people (20 to 30).
45. Most people who commit suicide do not believe in an afterlife.
57
For each item, indicate (on the answer sheet) whether you: A. strongly agree B. agree C. are undecided D. disagree E. strongly disagree
46. In times of war, for a captured soldier to commit suicide is an act of heroism.
47. Suicide attempters are typically trying to get even with someone.
48. Once a person is suicidal, he is suicidal forever.
49. There may be situations where the only reasonable solution is suicide.
50. People should be prevented from committing suicide since most are not acting rationally at the time.
51. The suicide rate is higher for minority groups such as Chicanos, American Indians, and Puerto Ricans than for whites.
52. Improvement following a suicidal crisis indicates that the risk is over.
53. People who engage in dangerous sports like automobile racing probably have an unconscious wish to die.
54. Prisoners in jail who attempt suicide are simply trying to get better living conditions.
55. Suicide among young people (e.g., college students) are particularly puzzling since they have everything to live for.
56. Once a person survives a suicide attempt, the probability of his trying again is minimal.
57. In general, suicide is an evil act not to be condoned.
58. People who attempt suicide and live should be required to undertake therapy to understand their inner motivation.
59. Suicide is a normal behavior.
60. Many victims of fatal automobile accidents are actually unconsciously motivated to commit suicide.
58
For each item, indicate (on the answer sheet) whether you: A. strongly agree B. agree C. are undecided D. disagree E. strongly disagree
61. If a culture were to allow the open expression of feelings like anger and shame, the suicide rate would decrease substantially.
62. From an evolutionary point of view, suicide is a natural means by which the less mentally fit are eliminated.
63. Suicide attempters who use public places (such as a bridge or tall building) are more interested in getting attention.
64. A person whose parent has committed suicide is a greater risk for suicide.
65. External factors, like lack of money, are a major reason for suicide.
66. Suicide rates are a good indicator of the stability of a nation; that is, the more suicides the more problems a nation is facing.
67. Sometimes suicide is the only escape from life's proble~s.
68. Suicide is a very serious moral transgression.
69. Some individuals have committed suicide to preserve their honor; these were victims of cultural values rather than disturbed personal attitudes.
70. If someone wants to commit suicide, it is their business and we should not interfere.
71. A suicide attempt is essentially a "cry for help."
72. Obese individuals are more likely to commit suicide than persons of normal weight.
73. Heroic suicides (e.g., the soldier in war throwing himself on a live grenade) should be viewed differently from other suicides (e.g., jumping off a bridge).
74. The most frequent message in suicide notes is of lonelinees.
59
For each item, indicate (on the answer sheet) whether you: A. strongly a~ree B. agree C. are undecided D. disagree . strongly disagree
75. Usually, relatives of a suicide victim had no idea of what was about to happen.
76. Long-term self-destructive behaviors, such as alcoholism, may represent unconscious suicide attempts.
77. Suicide attempts are typically preceded by feelings that life is no longer worth living.
78. Suicide goes against the laws of God and/or of nature.
79. We should have "suicide clinics" where people who want to die could do so in a painless and private manner.
80. Those people who attempt suicide are usually trying to get sympathy from others.
81. People who commit suicide lack solid religious convictions.
82. People with no roots or family ties are more likely to attempt suicide.
83. People who bungle suicide attempts really did not intend to die in the first place.
84. Passive suicide, such as an overdose of sleeping pills, is more acceptable than violent suicide such as by gunshot.
85. Potentially, everyone of ns can be a suicide victim.
86. Suicide occurs only in civilized countries.
87. People who die by suicide should not be buried in the same cemetery as those who die naturally.
88. Most people who commit suicide do not believe in God.
89. Children from larger families (i.e., three or more children) are less likely to commit suicide as adults than single or only children.
90. Suicide at tempters are, as individuals, more rigid and less flexible than non-attempters.
91. The large majority of suicide attempts result in death.
60
For each item, indicate (on the answer sheet) whether you: A. strongly agree B. agree C. are undecided D. disagree E. strongly disagree
92. Some people are better off dead.
93. People who attempt suicide are, as a group, less religious.
94. As a group, people who commit suicide experienced disturbed family relationships when they were young.
95. People do not have the right to take their own lives.
96. Most people who attempt suicide fail in their attempts.
97. Those who commit suicide are cowards who cannot face life's challenges.
98. Individuals who are depressed are more likely to commit suicide.
99. Suicide is much more frequent in our world today than it was in early cultures such as Egypt, Greece, and the Roman Empire.
100. People who are high suicide risks can be easily identified.
Your responses are confidential and are being studied for reseach purposes only. It would be helpful to us if you would answer the following questions also (on the answer sheet).
101. Are you: A. Male B. Female
102. Your age: A. Below 18 B. 18-21 C. 22-25 D. 26-29 E. 30 or more
103. Have you ever taken a course on "death-and-dying" or on crisis intervention, or worked for a crisis center? A. Yes B. No
104. Have you ever seriously considered suicide? A. Yes B. No.
105. Have you ever attempted suicide? A. Yes B. No
106. Have you personally known someone who committed suicide: A. Yes B. No
107. If yes to the above question, was the person: A. a member of your immediate family (e.g., parent, sibling) B.a relative (e.g., cousin) C. a close friend D. an acquaintance
108. If no to question 104, have you personally known someone who attempted suicide? A. Yes B. No
109. If yes to the above question, was the person: A. a member of your immediate family (e.g., parent, sibling) B. a relative (e.g., cousin) C. a close friend D. an acquaintance
61
110. What is the probability that at some point in your life you might attempt suicide? A. zero B. less than 10% C. 50-50 D. somewhat probable E. highly probable
111. In answering a questionnaire like this, there are many reasons why some people may not be able or wish to be fully honest. In looking over your responses, should we: A. accept them as fully honest B. accept them but with some reservation C. probably disregard them
D. disregard them as not valid.
APPENDIX B
SUICIDE OPINION QUESTIONNAIRE SCORING KEY
62
63
SUICIDE OPINION QUESTIONNAIRE SCORING KEY
1. Favorable-Unfavorable (46 items)
Items scored as given
7, 9, 16, 19, 21, 29, 33, 38, 41, 43, 45, 47, 50, 55, 57, 58, 62, 63, 68, 78, 80, 81, 82, 87, 88, 90, 93, 94, 95, 97
2. Factual Items (35 items)
Items scored as given
6, 8, 14, 32, 34, 37, 41, 42, 44, 52, 56, 66, 72, 74 75, 86, 89, 91
Higher Scores = more favorable
Scores reversed
1, 2, 10, 13, 18, 23, 25, 35, 40, 46, 49, 59, 61, 67, 70, 85
Higher Scores = more factual knowledge
Scores reversed
3, 4, 12, 15, 17, 22, 24, 26, 28, 30, 36, 51, 64, 96, 98, 99, 100
APPENDIX C
SUICIDE INTERVENTION RESPONSE INVENTORY
64
65
SUICIDE INTERVENTION RESPONSE INVENTORY
The following items represent a series of excerpts from counseling sessions. Each excerpt begins wi th an expression by the client concerning some aspect of the situation he/she faces, followed by two possible helper responses to the client's remark. You are to select that response which you feel is the more appropriate reply to the client's comment, recording either "A" or "B" to the left of the item to indicate your preferred response. Be sure to select only one response per item, and try not to leave any item blank.
1. Client:
2. Client:
I decided to call in tonight because I really feel like I might do something to myself . I've been thinking about suicide.
Helper A:
Helper B:
You say you're suicidal, but what is it that's really bothering you? I'd like to hear more about your suicidal feelings •
• And now my health is going downhill too, on top of all the rest. Without my husband around to care for me anymore, it just seems like the end of the world.
Helper A: Try not to worry so much about it. Everything will be alright.
Helper B: You must feel pretty lonely and afraid of what might happen.
3. Client: But my thoughts have been so terrible. . I could never tell them to anybody.
Helper A: You can tell me. I'm a professional, and have been trained to be objective about these things.
Helper B: Some of our ideas seem so frightening to you, that you imagine other people would be shocked to know you are thinking such things.
4. Client: No one can understand the kind of pain I've been going through. Sometimes I just feel like I have to hurt myself, so I cut my wrists.
66
Helper A: You've been suffering so much that cutting your wrists seems to be the only way you can make the pain go away.
Helper B: But you're so young, you have so much to live for. How can you think of killing yourself?
5. Client: What are you anyway? Are you a doctor? How do you know what I've been been going through? You've probably always had it pretty soft.
Helper A: You're wondering if I can understand how you feel.
Helper B: You're not even giving me a chance. I've had a pretty rough life too; you're not the only one who's seen hard times.
6. Client: My life has been meaningless ever since my wife, Emma, died four years ago. The kids are grown and married now, and I've been retired from my job at the railroad for some time. It just seems that I'd be better off dead.
7. Client:
Helper A: But try to think of what Emma would want for you. She'd want you to continue leading a productive life, wouldn't she?
Helper B: It sounds like everything just collapsed around you when Emma died .
. But what has happened recently to make things even worse, to make you think that dying is the only
way out?
I really need help. • it's just. (voice breaks; silence).
Helper A:
Helper B:
It must be very difficult for you to talk about what's bothering you. Go on. I'm here to listen to you talk.
67
8. Client: When you sum up my problem like that, it makes it seem less confusing and not so scary.
Helper A: See, it really isn't so bad after all. It certainly isn't anything
you would think of killing yourself over, is it? Helper B: Well, I think it's still pretty
frightening, even though talking about it makes it a bit clearer. I think you realized how dangerous your suicidal feelings were, and that's why you decided to contact me.
9. Client: You were supposed to help me, but you've only made things worse.
Helper A: I'm sorry. I was only trying to help.
Helper B: You sound pretty angry.
10. Client: How could you ever help me? Have you ever wanted to kill yourself?
11. Client:
Helper A: You're concerned about whether I can understand and help you.
Helper B: Sure, I've thought about suicide sometimes. But I always found more realistic solutions to my problems.
I don't know. . this thing with my wife really gets to me. (Sobs.) I try so hard to keep from crying.
Helper A: Do you think that the reason it's hard for you to cry is because
you're a man? Helper B: With all the hurt you're feeling,
it must be impossible to hold those tears in.
68
12. Client: How can I believe in God anymore? No God would ever let this happen to me; I've never done anything to deserve what's happened.
13. Client:
14. Client:
Helper A: Things have gotten so bad, that it's difficult to see any meaning in the things that have happened to you.
Helper B: Well, God works in mysterious ways. Maybe this is His way of testing
your faith.
I don't know why I'm calling you. My family is financially well off, and my husband spends plenty of time with me, even though he has a successful law career. Even my kids have been doing well. They get good marks at school and have lots of free time activities with their friends. But nothing seems to interest me. Life is just a bore.
Helper A: Considering all you have going for you, your problems can't be all that serious. Try to focus more on the positive aspects of your situation.
Helper B: So even though things seem to be going well at one level, life still seems pretty depressing, even if it's hard to say exactly why.
I have to hang up now. My mother's coming home soon, and I don't want her to know I've been talking to you.
Helper A:
Helper B:
Okay, but if you keep feeling suicidal, remember you can always call back. All right, but first I want you to promise me you won't do anything intentional or unintentional to hurt yourself, until you call and
talk to me. Will you repeat that promise?
69
15. Client: Is it really true, that many people feel this way? I thought I was the only one who had such dreadful, sinful ideas.
Helper A: No, there are many people who suffer from mental illness. But with appropriate treatment by a qualified physician, some of these patients can be cured.
Helper B: It is true. You're not the only one who has suicidal thoughts. And you can be helped to get through this crisis, just as others have
been.
16. Client: I'm so lonely, so tired (crying). There just isn't anywhere left to turn.
Helper A: You seem so alone, so miserable •• Have you been feeling suicidal?
Helper B: Come on now. Things can't be. all that bad.
17. Client: (Over telephone.) It's hard to talk here, with all these people ••
Helper A: Helper B:
Would it help if I asked questions? Why don't you call back some other time when you can talk more easily?
18. Client: I have a gun pointed at my head right now, and if you don't help me, I'm going to pull the trigger!
Helper A: Helper B:
You seem to be somewhat upset. I want you to put down the gun so we can talk.
19. Client: Why sould you care about me, anyway?
Helper A: I've been trained to care about people. That's my job.
Helper B: Because I think your death would be a terrible waste, and it concerns me that things are so bad--that you
are considering suicide. You need me to get through this critical period.
20. Client:
21. Client:
22. Client:
70
I really hate my father! He's never shown any love for me, just complete disregard.
Helper A: You must really be angry at him for not being there when you need him most.
Helper B: You shouldn't feel that way. After all, he is your father, and he deserves some respect.
I don't think there's really anyone now who cares whether I'm alive or dead. It just
makes me feel so isolated.
Helper A: No one seems concerned about you anymore, and that leaves you pretty alone. Can you tell me more about how that makes you feel to be so isolated?
Helper B: Why do you think that no one cares about you anymore?
I tried going to a therapist once before, but it didn't help. . nothing I do now will change anything.
Helper A:
can do to Helper B:
You've got to look on the bright side! There must be something you
make things better, isn't there? You feel like nothing you do is important, and that a therapist can't help you. Hasn't anyone else been helpful to you before--maybe a friend, relative, teacher or clergyman?
23. Client: My psychiatrist tells me I have an anxiety neurosis. Do you think that's what's wrong with me?
Helper A: I'd like to know what that means to you, in this present situation? How do you feel about your problem?
Helper B: I'm not sure I agree with that diagnosis. Maybe you should seek out some psychological testing, just to be certain.
71
24. Client: I can't talk to anybody about my situation.
25. Client:
Everyone is against me.
Helper A: That isn't true. There are probably lots of people who care about you, if you'd only give them a chance.
Helper B: It must be difficult to find help when it's so hard to trust people.
(Voice slurred, unclear over telephone.)
Helper A: You sound tired. Why don't you get some sleep and call back in the morning?
Helper B: Your voice sounds so sleepy. Have you taken anything?
APPENDIX D
SIRI SCORING KEY: LIST OF FACILITATIVE ALTERNATIVES
72
73
SIRI SCORING KEY: LIST OF FACILITATIVE ALTERNATIVES
l. B 14. B
2. B 15. B
3. B 16. A
4. A 17. A
5. A 18. B
6. B 19. B
7 . A 20. A
8. B 2l. A
9. B 22. B
10. A 23. A
1l. B 24. B
12. A 25. B
13. B
REFERENCES
Anastasi, A. Psychological Testing. 1968.
New York: Macmillan,
Andriola, J. cide.
A Note on the Possible Iatrogenesis of SuiPsychiatry, 1973, 1£, 213-218.
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